Purpose: To evaluate the value of contrast-enhanced ultrasonography (CEUS) in the differentiation of high and low grade urothelial carcinoma. Materials and Methods: 192 with 192 bladder lesions, including 110 high grade urothelial carcinoma and 82 low grade urothelial carcinoma were examined by CEUS. Among 192 tumors, enhancement patterns of 96 tumors between August 2010 and December 2012 were analyzed retrospectively. Then from January 2013 to April 2015, compared with CEUS was performed on 96 tumors for prospective differential diagnosis. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value were assessed. Results: With the CEUS view, dominant enhancement patterns were revealed as fast wash-in and slow wash-out for high grade urothelial carcinoma, fast wash-in and fast wash-out for low grade urothelial carcinoma, respectively. At CEUS, the prospective differentiation of bladder tumors showed sensitivity 86%, specificity 90%, accuracy 88%, positive predictive value 92%, and negative predictive value 82% for high grade tumors, while sensitivity 85%, specificity 89%, accuracy 88%, positive predictive value 85% and negative predictive value 89% for low grade tumors, respectively. Conclusions: Our study demonstrates the great potential of CEUS in the differentiation of high and low grade urothelial carcinoma. Since CEUS is an effective, inexpensive, and non-invasive method. It could be a reliable tool in the evaluation of patients with bladder tumors.